The treatment of people with severe mental illness often means locking them away in large, impersonal facilities or letting them bounce between short stays at in-patient units at major hospitals, followed by a rapid decline of functioning sometimes resulting in homelessness, then back again. This is especially true for psychotic disorders such as experiencing hallucinations and hearing voices. It’s a broken, ineffective system with minimal respect and compassion for the patient, and hasn’t changed much in centuries. The only real change is that the patients are now highly medicated, often further hindering recovery. Many psychiatrists don’t believe a full recovery from severe psychotics disorders is even possible.

My wife is a therapist at a small non-profit organization that operates facilities for the severely mentally ill, usually including psychotic disorders. Their approach is radically different, with “community members” (not “patients”) living in an actual home in a small town, with full-time support via a trained “room mate” and therapists that spend several hours at a time with the community member. Their entire purpose is to help community members help themselves by understanding their issue, confronting it, and overcoming it – while living in society. It’s not traditional therapy, but more just being with them as a supporting companion. The person is treated as an equal, and respected to the extent that they are included in all treatment meetings.

The program is very expensive, not covered by insurance, and due to the highly respectful and individualized regimen, is difficult to scale. But it is also very effective, with lasting results.

To further understand the concepts behind the program, my wife is reading one of the foundation texts, Recovering Sanity by Edward Podvoll. I always like to explore and learn something a bit different, so I thought I’d read it too. The author tells several stories of people who have been able to fully recover from severe psychotic disorders by becoming self-aware and confronting the psychosis on their own.

One such person was John Perceval, who was an English nobleman in the very early 1800s. He began to hear voices, started to listen and respond to them, and consequentially was institutionalized in an asylum for several years. He goes through a cycle of first listening to the voices, responding to and being guided by them, then being self-aware enough to doubt the voices. Those doubts create moments of clarity that allow him to confront the “spirits and demons,” and after a lot of hard work and introspection he is then eventually able to fully recover. But the system doesn’t believe recovery is possible, so it takes several more years before he is released.

Upon his release he sues the asylum, various doctors, and even his mother for malpractice. Perceval publishes the detailed notes he kept (and hid) while institutionalized, leading to public awareness of the problem. He goes on to found a patient advocacy group that was very successful in changing the English laws to support, respect, and show compassion for the patients. This included mandating a judicial review before confinement, improved conditions inside hospitals, treatment regimens that include using homes and keeping families and especially children together, and standardized care models backed by outcomes and science, not societal fear and paranoia.

This was in the mid-1800s, in England. And he was building off of similar changes that had already taken place in France a couple decades earlier. How little has changed since then, and perhaps we’ve even regressed.

The core concept driving my wife’s organization is a rejection of “asylum mentality.” Asylum mentality is the traditional method of exerting power over others, in this case “therapeutic power” which leads to “therapeutic aggression” that can thwart the process of recovery. Instead the patient, the community member, is respected as an equal, and is supported while he or she actively confronts the psychosis.

It’s a much longer process, but far more sustainable as the person learns how to take individual corrective action when relapses occur. There is also the recognition, and acceptance, that recovery is non-linear. Setbacks are to be expected, and learned from.

In a way, that’s analogous to a lean transformation (and I don’t really like that term – it’s a journey). The ones that are the most solid and sustainable take a long time, but the organization understands the underlying concepts. It is not just a set of tools that can be thrown at a problem, perhaps by a consultant from outside the organization, but a true understanding of why it is being done. What is the problem or opportunity and what is the appropriate tool for that specific circumstance? What is the next experiment being run within a scientific PDCA problem-solving framework? It’s the power of owned understanding versus simply being told what to do.

That’s not the only analogy. Another one has to do with observation, which is critical to both recovering from psychosis and a lean transformation. Consider what Podvall, and indirectly Perceval, say in Recovering Sanity:

Asylum preserves what is called “non-reciprocal observation.” One is observed without being able to observe properly. One’s state of mind – mistakes, awkwardness, and transgressions – is catalogued, diagnosed, and studied; whereas one’s own observations are held in suspicion and doubt and are called unsound, resistance, arrogance, transference, and the like. An examination by the insane of their conditions, including the state of mind and therapeutic intentions of all their caretakers, is more or less prohibited. It is a situation bound to evoke paranoia.

So when a leader goes to the gemba and observes the process, is it non-reciprocal or reciprocal? Is just the leader observing or are others involved? What lenses, or biases, is the observer limited by? Is the patient, the people working at the gemba, involved? Are they being heard, respected, and shown empathy and compassion? Are they being taught to observe, to learn, to own, and to confront and fix the problems?

Supporting, respecting, and encouraging the patient to observe, understand, and take action to confront issues is what makes change effective and sustainable.

In the late 1990s I was working in the Silicon Valley for a Fortune-50 medical device company, responsible for a drug infusion pump manufacturing operation. I had just completed a crazy period where I had also “temporarily” (months and months…) led the advanced engineering department after that manager had transferred to a different location. I was finally settling back into one job when I was offered a position to run the company’s largest molding facility in a different state. Of course I accepted, without asking more than a couple questions.

A month later I arrived to a large operation with 60 heavy presses in a monster cleanroom, running at full capacity, 24/7/365, to make medical device components for other company operations throughout the world. And it was several months behind schedule. Downstream plants were shutting down every week, the scrutiny (“help”) from corporate was enormous, and I knew I wouldn’t be sleeping much for a while.

How do you increase capacity, quickly, when you’re already pushing every machine to the limit, around the clock?

This became my introduction to lean. We went down the traditional path of spending millions on new presses, which had a lead time of a few months. In the meantime I also did some research and came across the Association for Manufacturing Excellence where some fine gents like Doc Hall, Dan McDonnell, and Dave Hogg taught me about quick changeover. By the time the new presses arrived we had caught up with demand and were even starting to think about retiring old presses. I was hooked on lean and it changed the trajectory of my career. Gemba Academy, and our strong support of AME, is one way I try to give back to help others be similarly successful.

But that’s not the point of this story. Those of you who have worked at 24/7 facilities know that the night shifts can be a bit crazy – or even scary. This operation worked a 4/3/3/4 rotation of 12 hour shifts, which gives the benefit of long weekends but can be pretty grueling long hours. I soon learned about some “interesting” issues on the night shift. Let’s just say that sex, drugs, and rock ‘n roll covers about 50% of it, with the other half being quality and productivity. Which is how you’d like critical medical device components to be made, right? Perhaps I should have asked a few more questions before taking the job?

On the positive side I had a terrific staff that genuinely wanted to improve the operation. They gave a young kid like me a lot of support, even when I started trying those crazy lean ideas that my new AME friends were telling me about. But even before we dug into quick changeover, and before I knew what a “gemba” was, I knew we had to get those issues on the night shift resolved.

I thought a big reason for the issues was lack of attention and awareness by the managers, who primarily worked the day shift. So I had my first idea: once a month we’d have our staff meeting at midnight.

You can imagine how that went over. Ka-boom.

To their credit, my entire extended staff (I requested that supporting managers from QA, finance, HR, etc also attend) really did show up for that first meeting, even though some of them had an hour commute. We went over the usual agenda items for a half hour, then we all went and walked around. We met people we had never seen before, talked to supervisors, and experienced the operation at night. What was planned to be a one hour meeting actually ended around 3am… there was just so much to see and learn.

We realized that the issues weren’t just due to a lack of awareness by the day shift managers, but were usually driven by the night shift feeling like they were being ignored and unsupported. They also experienced unique problems ranging from being unable to quickly change to a new job due to lack of materials control and QA support to having a much worse break and “lunch” experience due to the cafeteria and nearby fast food options being closed. Snowy parking lots weren’t plowed at night, without natural light the factory felt more dark and cold, and the perception was that they were outcasts and loners even though many wanted that shift for a variety of reasons – usually to support their families.

Our eyes were opened, we paid attention, and we took action. Over the next several months most of the issues were resolved and the productivity and quality of the night shift began to match the day shift. We were also able to capture and capitalize on the ideas and creativity of that shift, and since they had operated so independently they were actually better at developing and implementing solutions than the day shift.

As Toyota’s Fujio Cho famously said, “Go see, ask why, show respect.”

Before we even knew about Toyota and lean, we realized the power of going to the gemba, discarding preconceived beliefs, and listening to and supporting the people. When we soon began to try quick changeover and then other lean tools, that respect paved the way for more support, enthusiasm, and results.

It seems that the more places I see and experience, the bigger I realize the world to be. The more I become aware of, the more I realize how relatively little I know of it, how many places I have still to go, how much more there is to learn. Maybe that’s enlightenment enough – to know that there is no final resting place of the mind, no moment of smug clarity. Perhaps wisdom, at least for me, means realizing how small I am, and unwise, and how far I have yet to go.– Anthony Bourdain

Forty-five years ago, my parents uprooted our family from a comfortable existence in west Texas and moved to Peru, which at the time was in the middle of a military dictatorship. This was before the internet and Amazon, news and our usual comforts were hard to come by, and the heavily-armed police on every corner were a little disturbing. My sister and I weren’t exactly thrilled about leaving our friends and first world problems, nor did we appreciate seven years of visiting probably every nook and cranny in Latin America.

Now I am very, very thankful. The experience gave me a perspective of the world that has proven invaluable in life and my career, as well as a wanderlust that has led me to visit over 65 countries. I always encourage people to go overseas with their kids, even if just for a visit, as the experience is truly life-changing.

There were a lot of Americans in Peru at the time, thanks to the oil and copper industries, and we attended a large American school. I was on the swim team, which was often like a mini Olympics – we competed against the British, Japanese, and German schools. But we didn’t just hobnob with expats – my parents insisted that we spend a lot of time with typical Peruvians, at all levels of the socioeconomic scale. We’d take long trips on back roads through small villages, spend a Sunday afternoon tramping through a slum trying to find a furniture woodworker, and go to parties at the homes of dad’s local staff.

My wife and I have carried that concept with us when we travel – domestic and overseas. Instead of spending weeks planning how we’re going to hit all the tourist hot spots, we’ll often do a quick scan of a guide book on the plane over and perhaps a quick traditional tour the first day. Then we spend the rest of our time off the beaten path, trying to learn how typical people live. Yes, we miss a lot of museums, but I think we gain a more real understanding of the locale.

Some memories are truly special. We’ll always remember spending Christmas at an orphanage in Panama, sipping tea with villagers in the high mountains of Bhutan, touching old bullet holes in the walls of a new yoga studio in Bosnia-Herzegovina, visiting a hospital in Tanzania (that happens to apply lean principles – see the impromptu video series I filmed for Gemba Academy!), having a beer while listening to a concert in a small beach town in Cuba, and contemplating the incredible violence of years past while having a sunset drink at a café on the Mekong River in Laos.

The experiences change you. They are truly a gemba, as value is created there both for the local people and for us in terms of accurate perspectives on the world. Reality is often far different from what many people think it is, especially in the U.S. where so few people travel outside of the country, let alone continent. Sort of like running a factory from a conference room instead of visiting the shop floor.

The walls of our home are filled with photos of our travels, almost all with people. The old man in the photo above, taken in Dhulikhel outside of Kathmandu in Nepal, still haunts me. Take a moment and really look at the leathered skin, the tired eyes, and the gnarled hands. You can almost feel the extreme hardship he’s endured. When I face a struggle I remember people like him and realize, again, how blessed I am to have the pure luck to be born where I was.

The passing of Anthony Bourdain in early June impacted me more than the death of any other celebrity, perhaps because I don’t really watch mindless TV or keep up with celebrities. Bourdain was an exception. We shared his love of food and travel, and especially how he went out of his way to connect with the local culture.

Over eleven seasons his Parts Unknown series visited 100 locations. Oftentimes we had already been where he went and could relive the experience, but several times he added new places to our wanderlist.

Lots has been written on how Bourdain struggled with his own demons. Maybe that’s why Bourdain was able to connect with people, creating real understanding, empathy, and compassion. And that’s why my wife and I connected with Bourdain’s show. In his travels he found what we also seek when we explore the world: a true understanding of the lives of people.

We live in strange, dark times that often seem bereft of fellow-feeling. For many (me included), Bourdain was an ideal of how empathy and curiosity could be wielded against the world’s ignorance and fearfulness. He felt deeply. Now he’s gone, and we’re still here. We need to be people who feel things deeply. We need to interrogate our assumptions about the world and the strangers in it. We need to try to know each other.

Rest in peace, Anthony. Thanks for inspiring us to discover and connect with real people.

When you are out observing on the gemba, do something to help them. If you do, people will come to expect that you can help them and will look forward to seeing you again on the gemba.
– Taiichi Ohno

I briefly introduced you to the concept of the gemba earlier in this book. The definition of gemba is “the real place” or “where value is created,” i.e., the production floor in a manufacturing company or a surgical ward in a hospital, and so forth.

I briefly introduced you to the concept of the gemba earlier in this book. The definition of gemba is “the real place” or “where value is created,” i.e., the production floor in a manufacturing company or a surgical ward in a hospital, and so forth.

Walking the gemba is different. You go to where value is being created and do more than just walk. You observe the process and ask questions, such as: What is the ideal state? What is the standard? Is there a problem? What is causing the gap between the ideal and the current state? You also check with the area manager to see if she sees the same things you do. Respect your team by helping them see the gemba the way you do, and listen to them describe what they see.

Use the gemba walk as a daily method to observe the process, identify areas for improvement, support kaizen, and mentor others. During problem solving, your leadership team should be at the gemba observing the problem, not in a conference room discussing it.

In many Lean organizations, you will also see managers, executives—even presidents—with their desks at the gemba so they can observe it throughout the day. When my own team decided to put our offices on the second floor of a new building, we faced some potential downsides by being away from where the work was being done. However, our production operators and supervisors were developing rapidly and becoming independent and confident in their capabilities, so we felt that if we put our executive team on the shop floor, we would stymie that growth, which wouldn’t be respecting people.

On the other hand, consider what I witnessed at the Sheraton Hongqiao in Shanghai a few years ago. As I walked into the bustling lobby of this large hotel, a man was working at a desk on the side. It was Thomas Mueller, the hotel’s general manager. Mueller would work from that desk most of the day, able to directly observe the key gemba of his operation. Despite being very busy, he welcomed questions from guests, and if he had to leave for a few minutes, his assistant took over. Working in a bustling lobby probably wasn’t the most productive location, but for him it was the most valuable one.

If you want to find out what is truly going on at your company, get out of the office or conference room and go and see what is happening where value is being created. Find the gemba and actively observe it, then look for ways to improve the work taking place there.

Mindful observation takes effort and practice, but it is very valuable if you want to be a leader. It allows you to watch processes in action and look for small nuances and opportunities for improvement. For example, the wait staff at top-tier hotels do this every day. One waiter is always watching, looking for a shift in a customer’s eyes that says she might need something, detecting a growing line of people waiting to be seated, or checking on food that needs to be delivered. This allows the staff to anticipate and resolve problems, often before the customers are aware they exist.

Being able to closely observe a situation allows things to flow much more smoothly.

The benefits of observation extend to the manufacturing setting as well. Taiichi Ohno had an exercise for his engineers and students where he’d draw a circle on the factory floor and tell them to stand in it and simply observe for a half hour. If they came back and reported that they didn’t see anything to improve, he’d send them back out.

The Ohno Circle exercise is very powerful and can be used on the factory floor, in the finance department, or even at home with the kids. In fact, it’s probably even more powerful in areas where processes are not visible or visibly defined. Just stand and watch. Resist the temptation to immediately jump into action. Think about and record what you’ve observed. Then improve it. In the Lean world, this is genchi genbutsu—go, see, and observe.

High-end hotels generally have observation down to a science. It is a core component of how they deliver great service. Several years ago, I was having a quiet breakfast at the Four Seasons in Bangkok after arriving late the previous evening. My table was at the side of an open atrium, so I was able to watch the staff in action. I’ve always been amazed by how the Four Seasons staff, whether at the restaurants or elsewhere, will be at your side exactly the instant you need them, but are also never annoyingly intrusive. Now I know how they do it.

Amidst the flurry of wait staff running around, I noticed there was always at least one person just standing and watching. It was not always the same person, but there was always one just looking around the room at the customers and the rest of the staff. If a customer looked up and around, indicating they needed something, the observing wait person immediately went over to that customer, while another staff member took over the watching and looking. If a line started to form at the front of the restaurant, the observer would head over and help with the seating. If another member of the wait staff needed help, he or she would have it within seconds and someone else would take over the watching. Someone was always standing, observing, and watching.

To test my own observation, I looked up and to the side, as if I needed something. Instantly, a waiter was at my side. I asked what he was watching for, and his response? “Just observing, sir.” Yes, “just” observing. There was no “just” about it. Observation is a key to their exceptional customer service. I wanted to ask if process improvements were identified and acted on, but the language barrier between my server and me hindered our conversation.

When observing a process, be it on the factory floor or in the accounting office, it is important to mindfully observe without prejudice, staying in the present, without trying to identify solutions. Simply watch, look for details, and, when appropriate, document them.

I recently came across the following TED Talk by Chimamanda Ngozi Adichie where she talks about the “danger of a single story.” From growing up as a kid in Nigeria to studying in the United States and into adulthood, she describes how both herself and others, having only heard a single story about a certain situation, critically misunderstand the person or circumstance.

We all experience the power of the single story, often without realizing the danger. How many of us get our news of the world, and thereby form opinions, from just a single news source? Or even worse, from news sources that we believe already reflect our opinions, thereby denying us the need to have to think about other perspectives, resulting in an increasingly polarizing form of confirmation bias?

How many of us as leaders simply listen to the single story told to us by our staffs, or perhaps even just a computer system – both of which may be predispositioned or programmed to conform to our existing perspective?

The single story may be an incomplete picture of the situation – or even dead wrong.

This is the power of genchi genbutsu – go and see. Go to the real place to truly understand.

My wife and I both lived overseas as kids, and experienced the danger of the single story when interacting with friends and family back home. Perspectives and opinions were sometimes just plain wrong. This is why we love to travel and have visited over 60 countries. With each new place we try to learn about and understand the overlapping tapestry of stories to get a true sense of the people and place, which is almost always very different from what we expected from the single story we’d read or heard about before visiting.

In Laos, one of the few remaining hardcore communist countries, we learned about the vibrant undercurrent of capitalism that has put a TV in the middle of many Hmong grass huts – often showing western shows such as [shudder] The Real Housewives of Orange County. In Tanzania we ventured outside the game parks that most tourists stick to to see how a group of dedicated people are fighting an incredible infant mortality problem – which was documented in a Gemba Academy video series. In Panama last Christmas we left the relaxing beaches and spent a day at a women’s shelter in the very dangerous city of Colon. We’ve been to the slums of India, animal rescue organizations in Nepal, broke bread with villagers in a small hill town in Italy, witnessed the social impact of an entire generation of men murdered by the Khmer Rouge in Cambodia, and walked through the vibrant township of Soweto outside the nearly abandoned and squatter-filled inner city of Johannesburg in South Africa. Every place has many stories.

That tapestry of multiple stories is the real picture. Not the single story that you read about in the paper or hear about on CNN, let alone entertainment channels like Fox or The Daily Show.

As leaders we must do the same. We can’t rely on a memo from our staff or a report from an MRP system. Those are single stories, and will invariably be an incomplete picture – or just wrong. Just as a single story can give us a potentially dangerous misunderstanding about geopolitical events, so can it about situations within our organizations.

Go and see. Observe, ask questions, challenge, and reflect. Learn the many stories to understand the true situation.